肝硬化结节和小肝癌的影像学研究

doi:10.13491/j.issn.1004-714x.2019.02.028

中国辐射卫生

2019, Vol. 28

Issue (2): 218-222 DOI: 10.13491/j.issn.1004-714x.2019.02.028

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肝硬化结节和小肝癌的影像学研究

刘悦, 康澍, 赵天佐, 张伟, 宋志超, 张殷雪, 张洁

北京中医药大学东直门医院放射科, 北京 100700

Imaging study of cirrhotic nodules and small hepatocellular carcinoma

LIU Yue, KANG Shu, ZHAO Tianzuo, ZHANG Wei, SONG Zhichao, ZHANG Yinxue, ZHANG Jie

Department of Radiology Dongzhimen Hospital Affiliated to Beijing University of TCM, Beijing 100700 China

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摘要肝硬化和肝癌有着密切关系，肝硬化结节经过再生结节（RN）、不典型增生结节（DN）、DN癌变，最终演变成小肝癌。诊断和鉴别肝硬化结节和小肝癌对临床早期干预提高生存率有着重要的意义。有相当一部分肝硬化结节和小肝癌在影像学表现上相互重叠，联合不同影像学检查技术，尤其是随着功能成像技术在临床上的广泛应用，必将有助于肝硬化结节和小肝癌的诊断、鉴别诊断及早期治疗。

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	刘悦
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	张洁

关键词 ：肝硬化, 再生结节, 不典型增生结节, 小肝癌, 超声, CT, MR

收稿日期: 2018-12-15

PACS:

R816.5

通讯作者: 张洁,E-mail:zj89260@163.com E-mail: zj89260@163.com

作者简介: 刘悦(1976-),女,黑龙江人,硕士,主治医师,研究方向是乳腺腹部影像诊断。E-mail:liuyue2013613@sina.com

引用本文:

刘悦, 康澍, 赵天佐, 张伟, 宋志超, 张殷雪, 张洁. 肝硬化结节和小肝癌的影像学研究[J]. 中国辐射卫生, 2019, 28(2): 218-222.
LIU Yue, KANG Shu, ZHAO Tianzuo, ZHANG Wei, SONG Zhichao, ZHANG Yinxue, ZHANG Jie. Imaging study of cirrhotic nodules and small hepatocellular carcinoma. , 2019, 28(2): 218-222.

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http://www.zgfsws.com/CN/10.13491/j.issn.1004-714x.2019.02.028 或 http://www.zgfsws.com/CN/Y2019/V28/I2/218

[1] 中华医学会.临床诊疗指南一消化系统疾病分册[M].北京:人民卫生出版社,2005.
[2] 刘伟文,杨宏远,纪建松.MRI及其定期随访对肝硬化结节癌变的诊断价值[J].医学影像学杂志,2013,23(12)1953-1955.
[3] Chatterjee R. Mitra A.An overview of effective therapies and recent advances in Biomarkers for chronic liver diseases and associated liver cancer[J].Int immunepharmacol,2015,24(2):335-345.
[4] 颜有霞,刘振堂,陈伟,等.肝硬化结节与小肝癌的MRI研究[J].医学影像学杂志,2011,21(12):1839-1841.
[5] Park Y N,Kim M J.Hepatocarcinogenesis:imaging-pathologic correlation[J].Abdom Imaging,2011,36(3):232-243.
[6] Ito K, Mitchell D G, Gabata T, et al.Hepatocellular carcinoma:association with increased iron deposition in the cirrhotic liver at MR imaging[J].Radiology,1999,212(1):235-240.
[7] Aihara T, Noguchi S, Sasaki Y, et al.Clonal analysis of regenerative nodules in hepatitis C virus-induced liver cirrhosis[J].Gastroenterology,1994,107(6):1805-1811.
[8] Terminology of nodular hepatocellular lesions[J].Hepatology,1995,22(3):983-993.
[9] Choi B I, Han J K, Hong S H, et al. Dysplastic nodules of the liver:imaging findings[J]. Abdom Imaging,1999,24(3):250-257.
[10] Park Y N. Update on precursor and early lesions of hepatocellular carcinomas[J].Arch Pathol Lab Med,2011,135(6):704-715.
[11] Ikeda K, Saitoh S, Suzuki Y, et al.Relationship of angiographic finding with neovascular structure detected by immunohistochemical staining of alpha-smooth muscle actin in small hepatocellular carcinoma[J].J Gastroenterol Hepatol,1998, 13(12):1266-1273.
[12] 任崧,叶兆祥,朱理珉.肝硬化结节多步癌变的病理及影像学表现[J].临床肝胆病杂志2011,27(4):425-428.
[13] Kojiro M. Roskams T.Early hepatocellular carcinoma and dysplastic nodules[J].Semin Liver Dis,2005,25(2):133-142.
[14] 钱林学,刘玉江,丁惠国.小肝癌的影像学诊断进展[J].世界华人消化杂志,2010,18(5):479-486.
[15] 林志光,王静.超声造影在肝硬化基础上不典型增生结节鉴别诊断中的研究进展[J].中国医疗设备,2017,32(7):97-100,123.
[16] 董杰.原发性肝癌的影像学诊断进展[J].河南医学研究,2011,20(3):367-370.
[17] Bota S. Piscaglia F. Marinelli S.et al. Comparison of international guidelines for noninvasive diagnosis of hepatocellular carcinoma[J]. Liver Cancer,2012,1(3/4):190-200.
[18] Yanagisawa K. Moriyasu F. Miyahara T. et al. Phagocytosis of ultrasound contrast agent microbubbles by Kuppffer cells[J].Ultrasound Med Biol,2007,33(2):318-325.
[19] 肖帆,周爱云.超声弹性成像的基本原理及临床应用现状[J].实用临床医学,2014,15(8):120-124.
[20] 石秋玲,张磊,徐金锋,等.声触诊组织定量技术鉴别诊断乙肝相关性小肝癌与肝硬化增生结节的应用价值[J]. 临床超声医学杂志,2017,19(5):305-308.
[21] Valls C, Andia E, Roca Y, et al. CT in hepatic cirrhosis and chronic hepatitis[J]. Semin in Ultrasound CT MR,2002,23(1):37-61.
[22] 徐辉,谢敬霞,杨正汉.肝硬化结节多步癌变的病理学及影像学研究进展[J].当代医学,2008,1(21):127-131.
[23] 赵夏平,李文祥,王维,等.小肝癌的早期诊断及研究进展[J].肝脏,2013,18(7):489-493.
[24] 贾翠宇,赵大伟,陈枫.慢性肝炎患者小肝癌(≤ 20mm)的MDCT影像表现[J].医学影像学杂志,2013,23(6):913-917.
[25] Bellissimo F, Pinzone M R, Cacopardo B, et al. Diagnostic and therapeutic management of hepatocellular carcinoma[J].World journ of Gastroenterology,2015,21(42):12003-12021.
[26] 张亮,周奇,范卫君,等.CT灌注成像对肝硬化结节及癌结节鉴别诊断价值的研究[J].中山大学学报(医学科学版),2009,30(4S):155-158.
[27] 程好堂,高友富,闫中锋.320排CT灌注成像联合MVD在原发性肝癌诊断中的应用价值[J].功能与分子医学影像学, 2017,6(4):1313-1317.
[28] 王爽,赵心明,林蒙,等. 肝脏CT灌注成像在肝癌早期诊断中的价值[J].放射学实践,2008,23(3):280-284.
[29] 雷雨欣,贺太平,张喜荣,等.CT能谱成像减少对比剂用量在肝脏增强扫描中的应用[J].中国中西医结合影像学杂志,2018,16(5):468-471.
[30] 任庆国,滑炎卿,李剑颖.CT能谱成像的基本原理及临床应用[J].国际医学放射学杂志,2011,34(6):559-563.
[31] 林晓珠,沈云,陈克敏.CT能谱成像的基本原理与临床应用研究进展[J].中华放射学杂志, 2011,45:798-800.
[32] 马凤,张志远,贾永军,等.宝石能谱CT在结核性胸腔积液和癌性胸腔积液鉴别诊断中的应用[J].中国医学影像学杂志2013,21(5):360-362.
[33] Yu Y X, Lin X Z, Chen K M, et al. Hepatocellular carcinoma and focal nodular hyperplasia of the liver:differentiation with CT spectral imaging[J]. Eur Radiol 2013,23(6):1660-1668.
[34] Krinsky G.Imaging of dysplastic nodules and small hepatocellular carcinomas:experience with explanted livers[J]. Intervirology,2004,47(3/4/5):191-198.
[35] Kogita S,Imai Y,0kada M,et al.Gd-EOB-DTPA-enhanced magnetic resonance images of hepatocellular carcinoma:correlation with histological grading and portal blood flow[J].Eur Radiol,2010,20(10):2405-2413.
[36] Cho Y K,Kim J W,Kim M Y, et al.Non-hypervascular hypointense nodules on hepatocyte phase gadoxetic acid-enhanced MR images:Transformation of MR hepatobiliary hypointense nodules into hypervascular hepatocellular carcinomas[J].Gut Liver,2018,12(1):79-85.
[37] Chen M I, Zhang X Y, Qi L P,et al.Diffusion weighted images (DWI)without ADC values in assessment of small focal nodules in cirrhotic liver[J].Chin J Cancer Res,2014,26(1):38-47.
[38] Nasu K. Kuroki Y.Tsukamoto T.et al.Diffusion- weighted imaging of surgically resected hepatocellular carcinoma:imaging characteristics and relationship among signal intensity,apparent diffusion coefficient,and histopathologic grade[J].AJR Am J Roentgenology,2009,193(2):438-444.
[39] Muhi A, Ichikawa T, Motosugi U, et al.High-b-value diffusion-weighted MR imaging of hepatocellular lesions:estimation of grade of malignancy of hepatocellular carcinoma[J].Journal of Magnetic Resonance Imaging,2009,30(5):1005-1011.
[40] 林展.3T磁共振动态配准技术灌注成像在识别肝硬化结节恶变中的应用[J].国际医药卫生导报,2017,23(8):1124-1127.
[41] 张小鹏,黄鹏.磁共振SWI与GRE-T₂*WI序列用于诊断脑海绵状血管瘤的价值[J].医学影像学杂志,2017,27(12):2402-2404.
[42] 杨文海,刘红宇,张雪红,等.磁敏感加权成像在肝硬化结节多步癌变中的临床应用[J].医学影像学杂志,2017,27(6):1112-1114.
[43] 王梅,张龙江.卢光明.肝硬化相关结节的MRI研究与进展[J].国际医学放射学杂志,2012,35(5):437-442.
[44] 罗琳,王劲.肝硬化结节自然病程的磁共振功能成像研究进展[J].国际医学放射学杂志,2009,32(3):245-249.
[45] 于德新,刘成,李传福,等.31P-MRS在肝脏良、恶性占位性病变中的诊断价值[J].山东大学学报(医学版),2009,47:118-120.